Mortality and Prognostic Prediction in Very Elderly Patients With Severe Pneumonia

2019 ◽  
Vol 35 (12) ◽  
pp. 1405-1410 ◽  
Author(s):  
Moon Seong Baek ◽  
Sojung Park ◽  
Jeong-Hee Choi ◽  
Cheol-Hong Kim ◽  
In Gyu Hyun
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Pneumonia Severity Index ◽  
Nursing Home Residents ◽  
Area Under The Curve ◽  
Severe Pneumonia ◽  
Operating Characteristics ◽  
Very Elderly ◽  
Pneumonia Severity ◽  
Prognostic Prediction

Introduction: Although prognostic prediction scores for pneumonia such as CURB-65 score or pneumonia severity index (PSI) are widely used, there were a few studies in very elderly patients. The aim of the study was to validate prognostic prediction scores for severe pneumonia and investigate risk factors associated with in-hospital mortality of severe pneumonia in very elderly patients. Methods: During the 6-year study period (from October 2012 to May 2018), 160 patients aged 80 or older admitted to medical intensive unit were analyzed retrospectively. Pneumonia severity was evaluated using CURB-65 score, PSI, Sequential Organ Failure Assessment (SOFA) scores, A-DROP, I-ROAD, UBMo index, SOAR score, and lactate. The outcome was in-hospital mortality. Results: The median age was 85 years (interquartile range: 82-88). Nursing home residents accounted for 71 (44.4%) and in-hospital mortality was 40 (25.0%). Logistic regression showed that chronic lung, mechanical ventilation, hemodialysis, and albumin were associated with in-hospital mortality of pneumonia. Using the receiver operating characteristics curve for predicting mortality, the area under the curve in pneumonia was 0.65 for the SOFA score, 0.61 for the CURB-65 score, 0.52 for the PSI, 0.58 for the A-DROP, 0.52 for the I-ROAD, 0.54 for UBMo index, 0.59 for SOAR score, and 0.65 for lactate. Conclusion: The performances of the CURB-65 and PSI are not excellent in very elderly patients with pneumonia. Further studies are needed to improve the performance of prognostic prediction scores in elderly patients.

scholarly journals Determinants of In-Hospital Mortality in Elderly Patients Aged 80 Years or above with Acute Heart Failure: A Retrospective Cohort Study at a Single Rural Hospital

2021 ◽  
Vol 10 (7) ◽  
pp. 1468
Author(s):  
Yusuke Watanabe ◽  
Kazuko Tajiri ◽  
Hiroyuki Nagata ◽  
Masayuki Kojima
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Stepwise Regression ◽  
Stepwise Regression Analysis ◽  
Antibiotic Administration ◽  
Very Elderly ◽  
Survivor Group

Heart failure is one of the leading causes of mortality worldwide. Several predictive risk scores and factors associated with in-hospital mortality have been reported for acute heart failure. However, only a few studies have examined the predictors in elderly patients. This study investigated determinants of in-hospital mortality in elderly patients with acute heart failure, aged 80 years or above, by evaluating the serum sodium, blood urea nitrogen, age and serum albumin, systolic blood pressure and natriuretic peptide levels (SOB-ASAP) score. We reviewed the medical records of 106 consecutive patients retrospectively and classified them into the survivor group (n = 83) and the non-survivor group (n = 23) based on the in-hospital mortality. Patient characteristics at admission and during hospitalization were compared between the two groups. Multivariate stepwise regression analysis was used to evaluate the in-hospital mortality. The SOB-ASAP score was significantly better in the survivor group than in the non-survivor group. Multivariate stepwise regression analysis revealed that a poor SOB-ASAP score, oral phosphodiesterase 3 inhibitor use, and requirement of early intravenous antibiotic administration were associated with in-hospital mortality in very elderly patients with acute heart failure. Severe clinical status might predict outcomes in very elderly patients.

scholarly journals Age is not the only risk factor in COVID-19: the role of comorbidities and of long staying in residential care homes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. D’ascanio ◽  
M. Innammorato ◽  
L. Pasquariello ◽  
D. Pizzirusso ◽  
G. Guerrieri ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Residential Care ◽  
Pneumonia Severity Index ◽  
Care Homes ◽  
Categorical Variables ◽  
Rank Test ◽  
Very Elderly ◽  
Arterial Blood

Abstract Background The actual SARS-CoV-2 outbreak caused a highly transmissible disease with a tremendous impact on elderly people. So far, few studies focused on very elderly patients (over 80 years old). In this study we examined the clinical presentation and the outcome of the disease in this group of patients, admitted to our Hospital in Rome. Methods This is a single-center, retrospective study performed in the Sant’Andrea University Hospital of Rome. We included patients older than 65 years of age with a diagnosis of COVID-19, from March 2020 to May 2020, divided in two groups according to their age (Elderly: 65–80 years old; Very Elderly > 80 years old). Data extracted from the each patient record included age, sex, comorbidities, symptoms at onset, the Pneumonia Severity Index (PSI), the ratio of the partial pressure of oxygen in arterial blood (PaO2) to the inspired oxygen fraction (FiO2) (P/F) on admission, laboratory tests, radiological findings on computer tomography (CT), length of hospital stay (LOS), mortality rate and the viral shedding. The differences between the two groups were analyzed by the Fisher’s exact test or the Wilcoxon signed-rank test for categorical variables and the Mann-Whitney U test for continuous variables. To assess significance among multiple groups of factors, we used the Bonferroni correction. The survival time was estimated by Kaplan-Meier method and Log Rank Test. Univariate and Multivariate logistic regression were performed to estimate associations between age, comorbidities, provenance from long-stay residential care homes (LSRCH) s and clinical outcomes. Results We found that Very Elderly patients had an increased mortality rate, also due to the frequent occurrence of multiple comorbidities. Moreover, we found that patients coming from LSRCHs appeared to be highly susceptible and vulnerable to develop severe manifestations of the disease. Conclusion We demonstrate that there were considerable differences between Elderly and Very Elderly patients in terms of inflammatory activity, severity of disease, adverse clinical outcomes. To establish a correct risk stratification, comorbidities and information about provenience from LSRCHs should be considered.

Mechanical Ventilation for Very Elderly Patients with Severe Pneumonia

2014 ◽  
Vol 17 (4) ◽  
pp. 383-384 ◽  
Author(s):  
Miyuki Mitamura ◽  
Kosaku Komiya ◽  
Hiromi Watanabe ◽  
Jun-ichi Kadota
Keyword(s):  
Mechanical Ventilation ◽  
Elderly Patients ◽  
Severe Pneumonia ◽  
Very Elderly

scholarly journals Pneumonia Severity Index and CURB-65 score as a Predictor of In-Hospital Mortality in Acute Exacerbation of COPD

2020 ◽  
Vol 9 (11) ◽  
pp. 247-253
Author(s):  
Pankaj Kumar Singh ◽  
Mohit Bhatnagar ◽  
Sandeep Nimba Deore ◽  
Mandeep Joshi ◽  
Tausif Ahmed ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Acute Exacerbation ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Pneumonia Severity ◽  
Acute Exacerbation Of Copd ◽  
Exacerbation Of Copd

scholarly journals Prognostic Accuracy of the qSOFA Score for In-Hospital Mortality in Elderly Patients with Obstructive Acute Pyelonephritis: A Multi-Institutional Study

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2277
Author(s):  
Yudai Ishikawa ◽  
Hiroshi Fukushima ◽  
Hajime Tanaka ◽  
Soichiro Yoshida ◽  
Minato Yokoyama ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Acute Pyelonephritis ◽  
Young Patients ◽  
Area Under The Curve ◽  
Predictive Performance ◽  
Initial Assessment ◽  
Prognostic Accuracy ◽  
Comorbidity Index ◽  
Qsofa Score

Prognostic accuracy of the quick sequential organ failure assessment (qSOFA) score for mortality may be limited in elderly patients. Using our multi-institutional database, we classified obstructive acute pyelonephritis (OAPN) patients into young and elderly groups, and evaluated predictive performance of the qSOFA score for in-hospital mortality. qSOFA score ≥ 2 was an independent predictor for in-hospital mortality, as was higher age, and Charlson comorbidity index (CCI) ≥ 2. In young patients, the area under the curve (AUC) of the qSOFA score for in-hospital mortality was 0.85, whereas it was 0.61 in elderly patients. The sensitivity and specificity of qSOFA score ≥ 2 for in-hospital mortality was 80% and 80% in young patients, and 50% and 68% in elderly patients, respectively. For elderly patients, we developed the CCI-incorporated qSOFA score, which showed higher prognostic accuracy compared with the qSOFA score (AUC, 0.66 vs. 0.61, p < 0.001). Therefore, the prognostic accuracy of the qSOFA score for in-hospital mortality was high in young OAPN patients, but modest in elderly patients. Although it can work as a screening tool to determine therapeutic management in young patients, for elderly patients, the presence of comorbidities should be considered at the initial assessment.

scholarly journals The prognostic and risk-stratified value of neutrophil–lymphocyte count ratio in Chinese patients with community-acquired pneumonia

2017 ◽  
Vol 15 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Ting Yang ◽  
Chun Wan ◽  
Hao Wang ◽  
Jiangyue Qin ◽  
Lei Chen ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Lymphocyte Count ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Serum Levels ◽  
Community Acquired Pneumonia ◽  
C Reactive Protein ◽  
Pneumonia Severity ◽  
Reactive Protein ◽  
Count Ratio

Community-acquired pneumonia is a common disease associated with high mortality. This retrospective study examined whether the neutrophil–lymphocyte count ratio (NLR), already widely used as an index of inflammation, can be used to predict in-hospital mortality of adults with community-acquired pneumonia. Clinical characteristics, CURB-65 and pneumonia severity index score of pneumonia severity, NLR, serum levels of C-reactive protein and procalcitonin, and in-hospital mortality were analyzed for 318 consecutive adults with community-acquired pneumonia admitted to West China Hospital between July 2012 and December 2013. The ability of NLR and other parameters to predict in-hospital mortality was assessed using receiver operating characteristic (ROC) curves. Results showed that NLR increased with increasing CURB-65 ( P < 0.05) and pneumonia severity index ( P < 0.05), and NLR correlated positively with serum levels of C-reactive protein (r = 0.239, P < 0.05) and procalcitonin (r = 0.211, P < 0.05). The median value of NLR was significantly higher among patients who died in hospital (11.96) than among those who were alive at the end of hospitalization (4.19, P < 0.05). Based on a cut-off NLR of 7.12, this index predicted in-hospital mortality with a sensitivity of 82.61% and specificity of 72.20% (area under ROC curve, 0.799). Predictive power was greater for the combination of NLR and serum levels of C-reactive protein and procalcitonin. These results suggest that NLR may be useful for predicting prognosis in Chinese adults with community-acquired pneumonia, and it may work better in combination with traditional markers.

scholarly journals One-Year Mortality Prediction in Elderly Patients With Suspected Pneumonia: The Usefulness of a Holistic Approach

2021 ◽  
Author(s):  
Alberto Nascè ◽  
Astrid Malézieux-Picard ◽  
Landry Hakiza ◽  
Thomas Fassier ◽  
Dina Zekry ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Rating Scale ◽  
Nutritional Assessment ◽  
Univariate Analysis ◽  
Pneumonia Severity Index ◽  
Mini Nutritional Assessment ◽  
Functional Independence ◽  
Pneumonia Severity ◽  
Severity Scores

Abstract Background Pneumonia has an impact on long-term mortality in elderly patients. The risk factors associated with poor long-term outcomes are understated. The purpose of this study was to identify the predictors of 1-year mortality in older patients having a suspicion of pneumonia, using usual pneumonia severity scores and geriatric evaluation’s scores focused on comorbidities, nutritional status and functionality. Methods Consecutive patients over 65 years old and hospitalized with a suspicion of pneumonia were enrolled in a monocentric cohort from May 2015 to April 2016. Three scores were used to assess patients’ comorbidities (Cumulative Illness Rating Scale-Geriatric, CIRS-G), malnutrition (Mini Nutritional Assessment, MNA), functionality (Functional Independence Measure, FIM) respectively. Severity of pneumonia was assessed by using the Confusion, Urea, Respiratory Rate, Blood Pressure, and 65-years old score (CURB65), the Pneumonia Severity Index (PSI) and Sequential Organ Failure Assessment score (SOFA). With the exception of CIRS-G, all the scores were obtained prospectively within 48 hours after admission. The main outcome was 1-year mortality. Dates of death were obtained by consulting the cantonal register of deaths. Each score was analysed in univariate and multivariate models and logistic regressions were used to identify contributors to 1-year mortality. Results 200 patients were included (51 % male, mean age 83.8 +/- 7.7). The 1-year mortality rate was 30%. Scores associated with 1-year mortality were CURB-65 (p < .001), SOFA (p < .05), FIM (p < .01), CIRS-G (p < .001) and MNA (p < .001) in univariate analysis. Only CIRS-G (p < .05) and MNA (p < .05) were significant predictors of 1-year mortality in multivariate analysis. Conclusions Long-term prognosis of pneumonia was poor and we identified that scores assessing comorbidities and malnutrition were important predictors of 1-year mortality. This should be taken into account for evaluating elderly patients’ prognosis, levels and goals of care.

scholarly journals Neutrophil-lymphoycyte-ratio, platelet-lymphocyte-ratio and procalcitonin for early assessment of prognosis in patients undergoing VA-ECMO

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Sebastian Roth ◽  
René M’Pembele ◽  
Alexandra Stroda ◽  
Catrin Jansen ◽  
Giovanna Lurati Buse ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Area Under The Curve ◽  
Final Analysis ◽  
Operating Characteristics ◽  
Early Assessment ◽  
Discriminative Ability ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Platelet Lymphocyte Ratio ◽  
Va Ecmo

AbstractThe use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasing, but mortality remains high. Early assessment of prognosis is challenging and valid markers are lacking. This study aimed to investigate Neutrophil–Lymphocyte Ratio (NLR), Platelet-Lymphocyte-Ratio (PLR) and Procalcitonin (PCT) for early assessment of prognosis in patients undergoing VA-ECMO. This retrospective single-center cohort study included 344 consecutive patients ≥ 18 years who underwent VA-ECMO due to cardiogenic shock. Main exposures were NLR, PLR and PCT measured within 24 h after VA-ECMO initiation. The primary endpoint was all-cause in-hospital mortality. In total, 92 patients were included into final analysis (71.7% male, age 57 ± 14 years). In-hospital mortality rate was 48.9%. Receiver operating characteristics (ROC) curve revealed an area under the curve (AUC) of 0.65 [95% confidence interval (CI) 0.53–0.76] for NLR. The AUCs of PLR and PCT were 0.47 [95%CI 0.35–0.59] and 0.54 [95%CI 0.42–0.66], respectively. Binary logistic regression showed an adjusted odds ratio of 3.32 [95%CI 1.13–9.76] for NLR, 1.0 [95%CI 0.998–1.002] for PLR and 1.02 [95%CI 0.99–1.05] for PCT. NLR is independently associated with in-hospital mortality in patients undergoing VA-ECMO. However, discriminative ability is weak. PLR and PCT seem not to be suitable for this purpose.

scholarly journals Age is not the only risk factor in COVID-19: the role of comorbidities and of long staying in residential care homes.

2020 ◽  
Author(s):  
Michela D'Ascanio ◽  
Marta Innammorato ◽  
Lara Pasquariello ◽  
Dario Pizzirusso ◽  
Giulio Guerrieri ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Residential Care ◽  
Pneumonia Severity Index ◽  
University Hospital ◽  
Care Homes ◽  
Categorical Variables ◽  
Rank Test ◽  
Continuous Variables ◽  
Very Elderly ◽  
Arterial Blood

Abstract Background: The actual SARS-CoV-2 outbreak caused a highly transmissible disease with a tremendous impact on elderly people. So far, few studies focused on very elderly patients (over 80 years old). In this study we examined the clinical presentation and the evolution of the disease in this group of patients, admitted to our Hospital in RomeMethods: This is a single-center, retrospective study performed in the Sant’Andrea University Hospital of Rome. We included patients older than 65 years of age with a diagnosis of COVID-19, from March 2020 to may 2020, divided in two groups according to their age (G1 65-80 years old; G2 >80 years old). Data extracted from the each patient record included age, sex, comorbidities, symptoms at onset, the Pneumonia Severity Index (PSI), the ratio of the partial pressure of oxygen in arterial blood (PaO2) to the inspired oxygen fraction (FiO2) (P/F) on admission, laboratory tests, radiological findings on computer tomography (CT), length of hospital stay (LOS), mortality rate and the viral shedding. The differences between the two groups were analyzed by the Fisher’s exact test or the Wilcoxon signed-rank test for categorical variables and the Mann-Whitney U test for continuous variables. The survival time was estimated by Kaplan-Meier method and Log Rank Test. Univariable Cox proportional hazard regression and ordinal logistic regression were performed to estimate associations between age, comorbidities and provenance from residential care homes and clinical outcomes.Results: We found that G2 patients had an increased mortaliy rate, also due to (the frequent prevalence of) multiple comorbidities. Moreover we found that patients coming from long-stay residential care homes appeared to be highly susceptible and vulnerable to develop severe manifestations of the disease.Conclusion: We demonstrate that there were considerable differences between Elderly and Very Elderly patients in terms of inflammatory activity, severity of disease, adverse clinical outcomes; moreover, to establish a correct risk stratification, comorbidities and information about provenience from residential care homes should be considered.

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